The Fourth Trimester Series: BIRTH

September 10, 2018

12 minute read

Sharing your birth story has almost become a rite of new motherhood passage, with both film and photography becoming pretty normal delivery room add on. And while there is plenty to say about, for me personally and for many other mums I’ve since met and spoken to, your little one’s entry into the world is but the tip of the iceberg. Indeed, it’s the ‘fourth trimester’—the twelve weeks following D-day, when your baby seems little more than a foetus outside the womb— that more often than not are the real challenge. So when thinking about how I wanted to share my experiences, it was the post-birth three months that I wanted to focus on. However, as every recovery is dependent on every individual birth here is the first in the series covering what I went through during Grey’s birth and what I wish I’d known before…

Now my son, Grey, is six months old I feel I can look back on the first tough months with a little more clarity and perspective, because when I was in them I was in total survival mode and its definitely taken me some time to process.

Of course, my experience is just one experience, but I do feel that some of the struggles I went through are broadly universal and there is SO MUCH I wish I’d known before I has my baby. And I had really researched. Left no stone unturned. Given it the real journalistic investigation. But the truth is that we are both culturally and individually reluctant to share a lot of the realities of early motherhood for a host of reasons including insecurity, patriarchy, female competition and innate maternal love (it’s a pretty potent list). That cocktail generally leaves first time mums on the first day of the most important job of their lives with a hotchpotch of manuals and friendly advice, only half admitting what lies ahead.

We hear whispers and hints of what happens when things don’t go quite as we planned. But if you don’t have girlfriends that can give it to you like it really is, you can feel up shit creek (quite literally at points) without a paddle. Equally we’re often told, ‘it’s better you don’t know,’ a logic I do understand to an extent as too much research can definitely lead to anxiety. However, Ive always been firmly in the knowledge is power camp and my heckles are immediately raised when women are told they don’t need information pertaining to their bodies. Forewarned, after all, is forearmed. So here we go: an series of uncensored accounts of what happens when you have a 9lb baby who won’t latch, won’t stop crying, won’t stop vomiting and how to deal with the exhaustion, boredom and disenchantment that is part and parcel of the fourth trimester. Enjoy!

The Lead Up To Delivery & Tips On Hospital Choices

I had a turbulent, anxious pregnancy and if I’m really honest, however tough these first weeks of motherhood were I often thought: at least I’m not still pregnant. I was not on my best form for the vast majority of my nine months and have spoken here about some of the challenges I went through. One of the biggest struggles was that I was carrying a bigger baby. My belly measured at the 99 centile from about 30 weeks and I was house-bound for the last month with pelvic girdle pain. Like so many of us, I’d stopped sleeping for than a few hours a night, found eating tough with acid reflux and was generally pretty down. I think we often forget that you don’t go into motherhood fresh—it’s like deciding to do an Ironman after running a couple of marathons: you’re already depleted and certainly not at your best.

“But the truth is that we are both culturally and individually reluctant to share a lot of the realities of early motherhood for a host of reasons including insecurity, patriarchy, female competition and innate maternal love (it’s a pretty potent list).”

By the end I was desperate to have a Cesarean birth. Like many other women I read that the NHS would offer a C-section if requested, then realized in practice it’s very difficult to make it happen. Last month, research published by childbirth charity Birthrights showed that only 26% of NHS Trusts were abiding by the advice from theNational Institute for Health and Care Excellence to allow a woman to choose their type of birth. You will find some hospitals—especially Dr led research hospitals—are more likely to offer choice, but the vast majortiy of us won’t get the choice that we were promised. And I really tried, speaking to multiple midwives, the head midwife, doctors and counsellors to persuade them but to no avail. They did however suggest I visited A&E for an emergency psychiatric evaluation, at which point I thought it was best to rein my requests…In the final disucssion about it, my midwife told me to, “put it out of my mind that there is choice to be made, because there isn’t one.” She cited the cost to the NHS and the fact that in her opinion no person in their right mind would put themselves through that type of operation. So basically, it’s your midwife’s decision, not yours. As mentioned before I was very well researched and provided ample rational reasons why I should try and avoid natural birth—but instead of being offered the option I was made to feel that I must be having a psychiatric breakdown. In retrospect, if I had realized that NHS hospitals in practice have very different attitudes to birth options, I wouldn’t have just chosen my closest hospital.

So my first big piece of advice is to really look into the hospital before you start your ante natal appointments. If you are adamant you want a water birth with no interventions, make sure your birth centre is fully on board. If like me you are not so sure you want to push out a 9+ pounder, look for a doctor-led hospital with an open attitude to elective C-sections. For those living in London, UCLH is a world class maternity training hospital with an anecdotally open stance to elective Caesareans, for example. It’s so important to feel that you have control over your own body, because the truth is that there are no guaranteed ‘safe’ ways to give birth – whatever happens it’s a lottery and whether you have a natural, assisted, planned or emergency cesarean birth there are pros and cons. But if you feel your agency has been taken from you it can be a crushing experience with countless negative consequences far beyond your delivery. I was certainly extremely angry in the weeks after my birth and blamed my midwives for forcing me into a birth I wouldn’t have chosen. I also felt like Id let myself down by not advocating loudly enough for myself. If you want an elective C-section you will be made to feel uppity, selfish and like you value yourself over your baby. You will also be led to believe that it is not possible on the NHS and potentially like me that you are losing your mind. But it is your right, so somewhere, somehow there must be recourse and a way to get the birth your want.

Another thing to be aware of with your hospital choice: the post birth overnight stay can be really bleak. You’ve just been through the most harrowing, exhausting hours of your life then you’re wheeled into a room a tiny room with three other couples, strip lighting and one shared bathroom. All that separates you is a very fine curtain. I had packed a suitcase, which poked out under the curtain slightly as there was no room to walk entirely around the bed which we got in trouble for about 72 times—the space limitations mean you should really pack as small a bag as possible. You can also hear everything that the other mothers and their partners are going through and the babies all wake each other up. For us, as the ward was so understaffed, there was a lot of hostility all around, with two full blown screaming arguments between nurses and patients in earshot. I’ve been in hospital several times, but these mini wards with snoring husbands, women in discomfort and babies shocked at the world they’ve just entered was the most intense situation I’ve ever experienced. I’ve since found out from new mum friends that there are hospitals which offer private rooms—they can’t be booked, but some including Chelsea and Westminster have them from around £300 a night. Other hospitals also offer you the opportunity to be transferred to their private wing for the post natal experience. It’s obviously deplorable that those that can afford to pay can have privacy and that there’s a two tier system even within the NHS. But I would give up a lot to not go through that first night under such stressful conditions, so I wanted to at least mention that it might be a consideration to take into account when choosing your hospital.

Now after six months of hindsight, I will hold my hands up and say my midwives were right in that I was physically and mentally able to have a natural childbirth. In the pros column, I’m relieved that I didn’t have to deal with a C-section recovery which by all accounts is no joke at all. I’m generally back to normal–for the caveats see the next articles in this series–and my 8-hour labour would have been even quicker if I hadn’t had an epidural which generally slows things down. There was no horror story and my birth was to all intents and purposes normal…But that doesn’t mean things all went smoothly.

The Actual Birth

At 40 weeks I’d had a ‘sweep’ (where a midwife manually breaks the membranes between your cervix and the baby’s sac which is about as comfortable as it sounds) and I’d been two cm dilated and fully engaged. That night I started to have pains, so got up and went to watch the TV and around 4am my waters broke. We went in an Uber (extremely slowly due to the huge snowfall that night) to the hospital and arrived into a pretty manic environment. Cutting a long story short all attempts at a drug free birth went out the window, mainly looking back because I wasn’t admitted to the birth centre until I’d got to 7cm dilation. Until then I was kept in what felt like a maternal holding pen with women waiting for C-sections and having inductions. Being fully in labour in that environment (the people next to us were watching Friends on an iPad) was pretty mortifying, especially as I spent about 2 hours projectile vomiting – something I had no idea about, but is apparently pretty common in labour. If it happens to you, don’t freak out, it’s just your body getting rid of everything it can before the main event. Do however demand something to be sick in, as my nurse tried to force me to be sick on maternity pads on the bed. Clearly, no-one, least of all a woman in labour, needs to see last night’s dinner regurgitated next to them.

In order to have a drug free birth you 100% need to be in a calm, reassuring environment where you feel like you can trust the people around you. I definitely did not have that experience and more than the pain, it was the insane stress that tipped me over. When we arrived at the hospital I was assessed by a young student who said she ‘thought’ I was still 2cm dilated, but she wanted to get a nurse to check. She then asked me if I ‘thought’ I should go home or not. Having never been in labour before, I obviously had no idea. Her assessment however, was never checked and even though I begged the nurses to look again, as my waters had broken they said they wouldn’t be able to assess me for another four hours. I knew things were progressing quickly and that I needed support, but was told that I wasn’t in active labour so I had to keep on with the gas and air (not great if you’re puking the whole time). By the time I finally persuaded a nurse three hours later to look, I was so far beyond the point of no return when it came to the pain and worry. I made them promise I could have an epidural and agreed to walk (crawling would be more accurate) to the birth centre. However, it was a con and by the time I’d got there (the nurses wouldn’t let me have a wheelchair, even though my boyfriend and mum ended up carrying me) they were running the birthing pool and telling me I wouldn’t need any pain relief after all. It was at this point I went full One Born Every Minute and screeched for the epidural I’d been demanding for hours.

Reluctantly the midwives agreed, but we had to wait another hour for the anaesthetist as my bloods hadn’t been taken when I’d been admitted, and they need to check it before they will give it to you—another thing which is really worth pressuring to get sorted, just in case you want the pain relief further down the line. I hear from lots of other mums that there are often lots of delays with epidurals with endless reasons given why it can’t be administered and the staff at the birth centre were not thrilled and tried to persuade me out of it. After my birth I was told I, ‘could definitely have done it without the epidural,’ as if it was a failure. All I can say is that I can’t recommend getting one more. Aside from taking away the pain, it almost totally relieved the stress and anxiety and completely changed the atmosphere.

“In order to have a drug free birth you 100% need to be in a calm, reassuring environment where you feel like you can trust the people around you. I definitely did not have that experience.”

After it was administered I slept for 90 minutes then we were pretty much ready to push. I could feel the contractions for the full two hours and 15 minutes that I was going and it certainly wasn’t ‘pain free’ as the epidural wears off, which I hadn’t entirely realized. But with the help of one midwife and one student midwife who were just incredible from the start to finish, we got there without any interventions. I know those two hours were hard and that the baby’s heartbeat dropped a couple of times, but I can’t really say much more than that because truly I can’t remember it. However full on it was—Grey got stuck on the pelvic bridge and it was a long second stage of labour—I really can’t recall much of it aside from knowing how bone knackered I was afterwards. Ultimately though, six months later, I’m not ruling out having another baby in the future, so it can’t have been that bad/ amnesia is a powerful force.

When I look back my biggest issue with my birth wasn’t the pain, it was the lack of decisions I was given and the way I was treated as incapable of knowing what was best for me. I still can’t understand why we’re not given a very clear pros and cons list of current statistics on different birth options and I definitely bristle at the way we’re treated as if we’re children who don’t know what’s best for them. In the months of struggle with pelvic floor issues post birth I felt really resentful that I hadn’t had the birth I would have chosen. But now the dust has settled, and things have improved, I feel more balanced about it. It’s obviously an anxious time and the NHS has to do its best with limited resources. Some of the care I received was incredible, some not so much. As for the birth it ended up being a game of two halves—very confused and hideously frustrating for the first 4 hours, then amazingly supportive and reassuring for the next 4 hours. I am both angry and unspeakably grateful for the care I received, which sounds crazy, but I don’t know how else to explain it and I think a lot of us are both humbled by the tireless work of nurses and midwives, yet enraged the ways in which are rights are routinely dismissed and undermined. Labour is fucking scary and there are no guarantees of anything, so to an extent you do just have to let go—which is not my strong suit. Our happy ending left both a sweet and bitter taste in my mouth and if I am ever blessed with another pregnancy, there is a lot I would do differently. But, in the end, just like my midwives had told me all the way through, we did make it and holding my little chubster in my arms that day is still one of the most awe-inspiring moments of my life.